What is it?
Sacroiliac Joint pain describes discomfort originating from the Sacroiliac Joint (SIJ).
The Sacroiliac Joint is located at the lower back. It is the Joint between your sacrum (located centrally at the base of the spine) and the ilium (the pelvic crests). The SI joint moves very little (less than 0.3mm!) and has some of the strongest ligaments in the body supporting it. Despite being such a strong structure, it can still be a source of pain, with evidence suggesting it contributes to up to 30% of lower back complaints.
Symptoms:
SIJ pain symptoms include pain felt over the lower back, buttock, hip, or pain originating from within the joint itself. The pain can be sharp and/or stabbing, indicating an acute injury or dull and aching, demonstrating a chronic injury. Muscle tightness and/ or weakness in the glutes, lower back, and core can often accompany this injury, as well as pain avoidant movement strategies.
Causes:
Despite its prevalence, the exact cause of sacroiliac joint pain is still unknown. Previously it was thought to be caused by either too much (hyper) or too little (hypo) movement within the joint. However, current research is moving away from this assumption and is now viewing SIJ pain as the result of a combination of biological, psychological, and social factors.
This said, it is known that SIJ pain is commonly reported by people who have experienced some kind of injury or trauma to the lower back, hip or pelvis. This may be from a sporting injury, pregnancy, childbirth, a car accident, or fall, any sort of injury in which a strong force travels through the joint and strains the supporting ligaments and soft tissues.
Diagnosis:
To determine if the SIJ is the source of your discomfort, it is recommended, you seek to have a consultation with a physiotherapist, osteopath, or chiropractor. During the consultation, SIJ pain may be diagnosed by the therapist conducting a thorough medical history and physical assessment. The physiotherapist will inquire about the location, severity, and history of the pain and any predisposing injuries that may have contributed. The physio will then have a look at your pelvis, lower back, and legs to observe for any structural asymmetries that may contribute to your pain and feel the area surrounding the joint whilst checking for symptoms.
The therapist will perform specific tests on the joint itself to isolate SIJ pain from lower lumber or hip pain. The most commonly used tests are the SIJ pain provocation tests. This include
- The compression test
- The distraction test
- The thigh thrust shear test
- A straight leg raise
The therapist will also assess muscle length and joint ranges and perform a functional movement analysis to identify any compensatory movement strategies, muscle weakness, or tightness that may have developed from or be contributing to the pain. If all the information gathered through the assessment indicates the SIJ as the source of the discomfort, you will be diagnosed with SIJ pain.
Treatment:
Treatment of SIJ pain is specific to the patients’ individual presentation. This is why it is essential to have a proper assessment with a therapist to determine your condition’s major contributing factors. Whilst all SIJ treatment will involve a combination of education, exercises, and manual therapy, some people’s rehab may be much more focused on lengthening tissues and creating mobility. In contrast, others may be much more focused on developing strength and retraining poor movement strategies.
Manual therapy techniques applied in the treatment of SIJ pain can include soft tissue massage, trigger point release, muscle energy techniques, and, if required, manipulations. Manual therapy techniques provide analgesic benefits to the area, which helps reduce pain and inflammation; however, they do not affect the joint itself.
Exercises to support SIJ pain will often focus on strengthening the lower back, glutes, and deep core muscles. Stretches prescribed to release muscles that pull on the SIJ include hamstring stretches, quad stretches, glute stretches, and stretches that target the lower back.
Strengthening for Glutes:
Stretching Front of Thigh and Glutes:
For those experiencing a lot of pain, the therapist may also decide to apply K-tape or rigid tape over the SIJ or lower back area to provide you with additional support and sensory feedback. In some cases patients can be fitted with a compression belt.
Things you can fo now!
If you are suffering from SIJ pain, here are some simple things you can do right now to assist you in relieving pain!
- Avoid sitting crossed legged
- Avoid single leg activities (e.g. lunges or lots of stairs)
- Maintain a relaxed equal posture
- Perform gentle movements
- Apply ice for acute injuries or a heat pack if you are experiencing a deep dull ache!
- Book online – to see a professional who can help.
Post by: Physiotherapist Sarah Loveband
